INTESTINAL CATARRH. 575 



connective tissue behind the colon), there are pains in the right 

 thigh, or a feeling of numbness ; the psoas and iliacus muscles are 

 infiltrated and cannot contract, so that the patient cannot raise his 

 thigh. In these cases, the patient usually lies on the right side 

 with the body bent forward, and dreads every movement ; for in 

 this position the abdominal muscles are less tense, and the psoas 

 and iliacus are most relaxed. 



With the above symptoms the disease has not unfrequently 

 attained its acme, and now gradually improves. As the typhlitis 

 disappears, the secondary inflammations cease, and the exudation 

 is gradually absorbed. In such cases, the pain in the abdomen sub- 

 sides ; the tumor, which had been regularly advancing toward the 

 median line of the body, again becomes smaller, and finally disap- 

 pears altogether. In the same way the pain and feeling of numb- 

 ness in the right thigh pass off, the psoas and iliacus may again be 

 contracted, and the thigh again raised. In unfavorable cases, the 

 inflammation gradually affects the whole peritoneum, or the incap- 

 sulated exudation is not absorbed, but keeps up a chronic peritoni- 

 tis, and the patient succumbs to the protracted fever accompanying 

 this disease. Finally, the walls of incapsulated exudation may 

 gradually ulcerate, and there may be perforation outwardly, into 

 neighboring parts of the intestines, or into other organs ; we shall 

 enter into this more particularly when speaking of peritonitis. Bad 

 termination of the peritonitis, particularly its rapid spread over the 

 entire peritonaeum, should excite the suspicion that the ulceration 

 of the caecum has led to perforation ; however, perforation is quite 

 rare in this form, and there are very few cases where it can be cer- 

 tainly recognized during life. When perityphlitis results in forma- 

 tion of abscess and burrowing of the pus, its terminations are very 

 varied (see Chapter VI.). 



Ulceration of the processus verinif ormis is usually accompanied 

 by pain in the right iliac region ; but this is usually so undecided 

 that it is almost always impossible to interpret it correctly. It is 

 not till the ulceration has reached the peritonaeum, or when this 

 has been destroyed and the above-described symptoms of partial 

 peritonitis or those of perityphlitis occur, that the disease can be 

 recognized. We could not at all determine whether the vermi- 

 form process or the caecum was the starting-point of the conse- 

 cutive inflammations, were it not for the absence of premonitory 

 symptoms and of the obstruction and vomiting, but particularly 

 of the characteristic tumor. If we are called to a case in a patient 

 where there is already extensive peritonitis or formation of pus 



